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Nature of Disorders of Speech, Voice, Fluency and Swallowing > L12 Swallowing > Flashcards

L12 Swallowing Flashcards

1
Q

five phases of swallowing

A
  1. Anticipatory
  2. Oral preparatory
  3. Oral Phase
  4. Pharyngeal Phase
  5. Oesophageal Phase
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2
Q

What does MBSImp stand for

A

Modified Barium Swallow Impairment Profile

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3
Q

what is MBSimp

A
  • a standardized approach to the instruction, assessment, and reporting of physiologic swallowing impairment
  • 17 components of the adult swallowing mechanism
  • includes a scoring metric
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4
Q

MBSImp Components

A
  1. Lip closure
  2. Tongue control during bolus hold
  3. Bolus preparation/mastication
  4. Bolus transportation/lingual motion
  5. Oral residue
  6. Initiation of pharyngeal swallow
  7. Soft palate elevation
  8. Laryngeal elevation
  9. Anterior hyoid excursion
  10. Epiglottic movement
  11. Laryngeal vestibular closure
  12. Pharyngeal stripping wave
  13. Pharyngeal contraction
  14. Pharyngoesophageal segment opening
  15. Tongue base retraction
  16. Pharyngeal residue
  17. Esophageal clearance upright position
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5
Q

what occurs during the oral and oral prepatory phases of swallowing

A

the sealing of the oral cavity, mastication of the bolus and transfer of bolus to the oropharynx

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6
Q

difficulty sicking or with bolus formation and propulsion

A

increased tone in lips/cheeks

sign of dysphagia

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7
Q

anterior spillage of food, drinks and saliva

A

reduced lip seal

sign of dysphagia

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8
Q

build up of material in lateral sulci

A

reduced buccal tone

sign of dysphagia

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9
Q

biting of tongue/cheeks and impaired bolus formation

A

reduced oral sensation

sign of dysphagia

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10
Q

difficulty with bolus formation and propulsion

A

reduced tongue movement

sign of dysphagia

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11
Q

difficulty with mastication

A

reduced jaw movement

sign of dysphagia

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12
Q

loss of bolus from oral cavity

A

tongue protrusion

sign of dysphagia

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13
Q
  • difficulty placing spoon/teat
  • food/liquid pushed out of mouth
A

tongue thrust

sign of dysphagia

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14
Q

difficulty propelling bolus posteriorly

A

disorganised anterior or posterior tongue movement

sign of dysphagia

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15
Q

difficulty breaking down bolus during mastication and manipulating bolus

A

dry oral mucosa

sign of dysphagia

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16
Q

involuntary lip and tongue movements

A

tardive dyskinesia

sign of dysphagia

17
Q

reduced recognition of bolus or inability to initiate swallow

A

swallow agnosia/apraxia

sign of dysphagia

18
Q

what occurs during the pharyngeal phase of swallowing

A
  • Reflexive initiation of the swallow.
  • The velum raises and seals the nasal cavity to prevent nasal regurgitation
  • the vocal folds close
  • the epiglottis closes over the trachea.
  • The pharynx contracts and pushes bolus down.
  • The upper oesophageal sphincter opens to let the bolus pass through and closes afterwards to prevent retrograde movement
19
Q

breakdowns which occur in the pharyngeal phase of the swallow

A
  1. Delay initiating the pharyngeal swallow
  2. Weak tongue base retraction
  3. Nasal regurgitation
  4. Reduced pharyngeal contraction
  5. Poor airway protection
  6. Reduced hyolaryngeal excursion
  7. Impaired UOS opening
  8. Reduced laryngeal sensation
  9. Weak reflexive cough
20
Q

aspiration

A

entry of material below the level of the true vocal cords

21
Q

Aspiration : Penetration Aspiration Scale (Rosenbek et al. 1996)

A
  1. Material does not enter the airway
  2. Material enters airway, remains above the vocal folds, and is ejected from the airway.
  3. Material enters the airway, remains above the vocal folds, and is not ejected from the airway.
  4. Material enters the airway, contacts the vocal folds, and is ejected from the airway.
  5. Material enters the airway, contacts the vocal folds, and is not ejected from the airway.
  6. Material enters the airway, passes below the vocal folds and is ejected into the larynx or out of the airway.
  7. Material enters the airway, passes below the vocal folds and is not ejected from the trachea despite effort.
  8. Material enters the airway, passes below the vocal folds, and no effort is made to eject
22
Q

what occurs during the oesophogeal phase

A
  • The bolus is transported through the oesophagus by peristalsis into the stomach.
  • The lower oesophageal sphincter opens to allow the bolus into the stomach and then closes to prevent reflux/regurgitation.
23
Q

breakdowns occuring in the oesophageal phase

A
  • Food impaction
  • Impaired oesophageal clearance
  • Reflux
  • Regurgitation
  • Laryngopharyngeal reflux
  • Oesophageal web
  • Diverticulum
  • Schatzkis ring
  • Fistula
  • GORD
  • Achalasia
  • Oesophageal cancer
  • Oesinophilic oesophagitis
24
Q

Causes of Dysphagia

stroke

A
  • Cortical
  • Subcortical
  • Brainstem
25
Q

what is iatrogenic dysphagia

A

dysphagia caused by medical treatment
1. Medication
2. Chemo/Radiation
3. Surgery
4. Intubation
5. Tracheostomy

26
Q

Causes of dysphagia

cancer

A
  • Head and neck
  • Lung
  • Brain tumour
  • Chemoradiation
27
Q

Causes of dysphagia

Neurological

A
  • Muliple sclerosis
  • Motor neuron disease
  • Guillain Barre syndrome
  • Parkinson’s disease
  • Huntington’s disease
  • Myasthenia gravis
  • Head injury/trauma
  • Dementia
28
Q

causes of dysphagia

gastroenterological

A
  • Oesophageal cancer
  • Achalasia
  • GORD
  • Diverticulum/web
  • Oesinophilic oesophagitis
  • Bariatric surgery
29
Q

causes of dysphagia

respiratory

A
  • COPD
  • Obstructive sleep apnea
  • Tracheostomy
  • Intubation
  • COVID-19
30
Q

causes of dysphagia

paeds

A
  • Pre-term babies
  • Cardiac/pulmonary diseases
  • Congenital syndromes
  • Cerebral palsy
  • Structural
  • Acquired (tumour, trauma)
  • Behavioural (food refusal)
31
Q

causes of dysphagia

other

A
  • Cervical spine surgery
  • Thermal/caustic burns
  • Infectious diseases (HIV, polio)
  • Psychiatric
  • Functional
32
Q

complications of dysphagia

A
  • Aspiration (/aspiration pneumonia)
  • Risk of choking episodes
  • Weight loss
  • Dehydration
  • Malnutrition
  • Feeding tube dependency
  • Antibioic cover
  • Increased or prolonged hospital admissions
  • Impaired quality of life
33
Q

immediate signs of aspiration

A
  • Wet vocal quality
  • Multiple swallows
  • Coughing when drinking or during meals
  • Respiratory wheeze (ins/exp)
  • ? Drop in oxygen levels
34
Q

delayed signs of aspiration

A
  • Spiking temperature
  • Weight loss
  • Repeated chest infections
  • Malnutrition
  • Dehydration
  • Pneumonia right lobe > left
35
Q

important factors to consider in aspiration

A
  • Patient’s response to aspiration (effective/ineffective cough, silent aspiration)
  • Amount of aspiration
  • Frequency of aspiration
  • Type of aspirate:
    • oropharyngeal secretions
    • liquid
    • food
    • reflux (pH value - acidic)
36
Q

predictors of aspiration pneumonia

Langmore et al, 1999

A
  1. Smoking
  2. Dependency for feeding
  3. Tube feeding
  4. Polypharmacy
  5. Multiple medical diagnoses
  6. Number of decayed teeth
  7. Dependent for oral care
37
Q

groups most affected by dysphagia

A
  • Pre-term babies
  • Children with congenital syndromes
  • Cerebral palsy
  • Stroke
  • Nursing home residents
  • People with cognitive impairment and dementia,
  • People who are hospitalised,
  • Head and neck oncology patients
  • Critical care/intensive care
  • Patients with progressive neurological conditions

Nature of Disorders of Speech, Voice, Fluency and Swallowing (12 decks)

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